[Show abstract][Hide abstract] ABSTRACT: The first cases of Hantavirus infection were reported in the first months of 2009 from the Zonguldak and Bartin provinces in Turkey. The aim of the study was to investigate the presence of Hantavirus infections in patients with laboratory findings associated with Hantavirus infection in Bartin prior to the epidemics. After screening a total of 314,577 records between 2007 and 2009, clinical and laboratory data from 442 patients meeting the criteria of coexistent thrombocytopenia, and elevated urea and creatinin levels were transferred to the statistical programme. Home visits were paid to 170 patients, 84 patients of whom consented to join the study. They completed a questionnaire was filled and gave a blood sample. Commercial anti-hantavirus IgG and IgM ELISA and immunoblotting assays were used, with seropositive samples being confirmed by FRNT. ELISA and/or immunoblotting assays detected 10 positive samples (10/84), although only 7/10 of these were recorded as positive by FRNT. FRNT positivity was statistically associated with the patient being female, the presence of a barn belonging to the house, and working in forest (p<0.05). In an endemic region, physicians must keep in mind that patients with thrombocytopenia and elevated urea and creatinin levels may indicate a Hantavirus infection.
[Show abstract][Hide abstract] ABSTRACT: Lyme disease or lyme borreliosis is a zoonosis caused by Borrelia burgdorferi transmitted by ticks, especially Ixodes species. Lyme borreliosis is a multi-systemic disease that invades the skin, musculoskeletal, cardiovascular and central nervous systems. Tick-borne encephalitis (TBE) is an important arboviral infection caused by tick-borne encephalitis virus (TBEV). The central nervous system is affected and the disease most often manifests as meningitis, encephalitis or meningoencephalitis. Previous studies have shown that B.burgdorferi and TBEV can be transmitted by the same tick species (Ixodes ricinus). Although the geographic location and climate is similar to some south-eastern European countries where lyme borreliosis and TBE have been reported, the incidence and prevalence of these diseases in Turkey still remain unclear. The aim of this study was to determine the seroprevelance of B.burgdorferi and TBEV in healthy population in Tekkeköy (41° 8-13' North; 36° 24-31' East), a district of Samsun province, Turkey with evidence of tick-borne disease and to explore the possible correlations of life styles of healthy individuals and prevelance. The cross-sectional study population included 419 people selected using a random proportional sampling method. All participants were asked at interview to complete a questionnaire and peripheral blood samples were collected. From the blood samples, B.burgdorferi IgG and IgM antibodies were evaluated using commercial ELISA (Euroimmun, Germany) and confirmed with Western blot (WB, Euroimmun, Germany). ELISA method was also used to asses IgM and IgG antibodies against TBEV, and neutralization test was used for confirmation. Of the 419 samples, 17 (4%) were positive for B.burgdorferi IgG by ELISA, however 14 (14/419; 3.3%) of them were confirmed by WB. B.burgdorferi seropositivity was higher among people living in rural areas, at an altitude of ≥ 400 meters and in locations ecologically suitable for wild boar and rabbits; seropositivity was also seen to be higher among dog owners (p= 0.001, p= 0.001, p= 0.001, p= 0.001, p= 0.018, respectively). For TBEV, two samples yielded IgG positive, and one IgM positive results by ELISA, however none of them were confirmed by neutralization assay. Nevertheless, one of those three TBEV ELISA positive samples, was found positive for West Nile virus specific antibodies with neutralization test. The results of this study emphasized the presence of tick-borne diseases in that specific region, and in this regard the need for public health interventions has been demonstrated.
[Show abstract][Hide abstract] ABSTRACT: In this study, we sought to describe the community seropositivity of pandemic influenza A (H1N1) in order to estimate immunity shortly after the peak of the first pandemic wave in two provinces in Turkey. This cross-sectional study was conducted in the provinces of Diyarbakir and Ankara, after the first wave of H1N1 incidences in 2009. It was designed to evaluate 276 houses in Diyarbakir and 455 houses in Ankara. Everyone living in these houses was included in the study. An antibody titer of ≥1:40 was considered as a positive result for all age groups. Antibody titers of ≤1:20 were considered as 1 while calculating the log titer and geometric mean. The pandemic H1N1 seropositivity was found to be 24.1% for Ankara and 27.7% for Diyarbakir. In Ankara, seropositivity was statistically associated with the 15-24 age group (odds ratio [OR] = 11.47), pandemic influenza A (H1N1) vaccination (OR = 20.95), and influenza-like illness history (OR = 1.60). In Diyarbakir, H1N1 seropositivity was associated with the 15-24 age group (OR = 8.99) and pandemic influenza A (H1N1) vaccination (OR = 9.94). Because individuals less than 25 years old played an important role in the community transmission of infection and were largely protected against the pandemic influenza A (H1N1) virus, these individuals should be given a high priority for pandemic influenza vaccination in the event of the emergence of another novel pandemic strain.
[Show abstract][Hide abstract] ABSTRACT: In this study, it was aimed to determine the frequency of the symptoms of influenza-like illness during influenza A (H1N1)v pandemic in two provinces where sentinel influenza surveillance was conducted and also to obtain opinions about H1N1 influenza and vaccination, H1N1 vaccination status and factors affecting vaccination. This cross-sectional study was conducted in the provinces of Ankara (capital city, located at Central Anatolia) and Diyarbakır (located at southeastern Anatolia). It was planned to include 455 houses in Ankara and 276 houses in Diyarbakır. The household participation rate in the study was 78.9% and 53.6% for Ankara and Diyarbakır, respectively. Our study was carried out between January-February 2010, with 1164 participants from Ankara and 804 from Diyarbakır, including every household subjects except for infants younger than 11 months and patients with primary/secondary immunodeficiency diseases. Data was collected by site teams consisting of a physician and a healthcare staff with informed consent. Of the participants 45.5% from Ankara and 35.3% from Diyarbakır stated that they had gone through an influenza-like illness. The most frequently indicated clinical symptoms were fatigue/weakness, rhinitis, sore throat and cough. The rates of admission to a physician with influenza like illness complaints were 50.6% and 58.7%; rates of hospitalization due to influenza-like illness were 1% and 1.5%, and rates of antiviral drug use were 3.8% and 1.9%, in Ankara ve Diyarbakır participants, respectively. The rate of personal precautions taken by the subjects for prevention from pandemic influenza were 59% and 53.3%, in Ankara and Diyarbakır, respectively. These precautions most frequently were "hand washing" and "avoiding crowded public areas". H1N1 influenza vaccine was applied in 9.3% of the participants in Ankara and in 3.7% of the participants in Diyarbakır. Vaccination rate was higher in both of the provinces in adults over 25 years old than children and adolescents and in patients with chronic underlying disease. None of the 25 pregnant participants were vaccinated against pandemic influenza. The educational background, employment status and quality of the job have been detected as factors affecting the status of being vaccinated with H1N1 influenza vaccine in both provinces. In addition, the percentage of having H1N1 influenza vaccination was found to be higher in subjects who had seasonal influenza vaccination previously and in 2009, than those who had not, and this difference was statistically significant in both provinces (Ankara p< 0.001, Diyarbakır p< 0.001). The mostly indicated post-vaccination adverse reactions reported by vaccinated participants were local sensitivity, muscle and joint pains, headache and malaise. The most frequent rationale for not being vaccinated against H1N1 were "I do not consider it necessary/I do not want" (Ankara 33.4%, Diyarbakır 27.4%) and "I do not believe/trust its efficacy" (Ankara 25.6%, Diyarbakır 22.6%). Those data emphasized the insufficient awareness of our population about the importance of pandemic influenza and vaccine. It is also believed that possible case definition in H1N1 case management scheme should be revised. In conclusion an important part of pandemic preparation plans is risk communication with the public to increase awareness and to prevent the missed opportunities.
[Show abstract][Hide abstract] ABSTRACT: Aim: The Haemophilus influenzae type b (Hib) vaccine was introduced into the routine immunization schedule in Turkey on January 1, 2007. This study investigates the immunity to Hib prior to the introduction of the vaccine. Materials and methods: Serum samples were collected from healthy volunteers between the ages of 6 months and 50 + years of age, living in the area of 26 health centers in the Samsun, Antalya, and Diyarbakir provinces during 2000-2001. In total, 1713 sera were selected for this study, and the younger age groups were given priority (range 0-82). A commercial ELISA test was used to measure anti-Hib IgG. Hib antibody concentrations of ≤ 0.15, > 0.15 to < 1.0, and ≥ 1.0 μg/mL were considered as non protective, short-term protection, and long term protection, respectively. The statistical analyses performed were the chi-square test and logistic regression. Results: The antibody levels considered non-protective were 58.0%, 35.3%, 28.1%, 19.8%, 18.4%, 15.3%, and 20.6% among < 5, 5-9, 10-19, 20-29, 30-39, 40-49, and 50 and over age groups, respectively. Protection against Hib infection increased by age in all 3 provinces. Conclusion: This study provides important baseline data on anti-Hib antibody levels in Turkey before routine immunization was introduced, and shows that there is a considerable percentage of subjects with non-protective antibody levels.
Turkish Journal of Medical Sciences 01/2010; 40(6):5-9. DOI:10.3906/sag-0811-50 · 0.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Serological methods are widely used for the laboratory diagnosis of syphilis or for screening purposes. The aim of this study was to determine an algorithm for the application of laboratory tests that will provide accurate diagnosis of syphilis in a cheap, fast and practical way. A total of 162 serum samples were evaluated by the following tests: VDRL (Venereal Disease Research Laboratory; Omega Diagnostic, UK), TPHA (Treponema pallidum Hemagglutination Test; Omega Diagnostic, UK), ELISA IgG + IgM (Enzyme Linked Immunosorbent Assay; DiaPro Diagnostic Bioprobes, Italy), FTA-ABS (Fluorescent Treponemal Antibody-Absorption; IgG, Euroimmun, Germany) and WB (Western Blot; IgG Euroimmun, Germany). When the gold standard was considered as FTA-ABS test, the sensitivity, specificity, positive and negative predictive values for VDRL were 77.1%, 100% 100% an 80.6%; for TPHA were 92.8%, 98.7%, 98.7% and 92.9%, for ELISA 98.8%, 98.7%, 98.8% and 98.7%, and for WB 98.8%, 100%, 100% and 98.7%, respectively. When the results of screening with VDRL together with TPHA were compared with FTA-ABS, it was observed that if both VDRL and TPHA results were positive, then there was 100% concordance between the tests. However, when both of the test results were negative, 1.3% of them yielded positive result with FTA-ABS. If either one of VDRL or TPHA results were positive (n = 24), 95.8% (n = 23) was positive with FTA-ABS. Therefore, inconsistent results obtained by VDRL and TPHA requires verification by another method. When ELISA or WB tests were used, the borderline results need verification, however, positive or negative results would be reported. The determination of an algorithm for laboratory tests also depend on the number of patients, cost, cost per positive patient and workload of the laboratory. Thus, ELISA could be selected when the number of cases is high and the results should be reported unless they are suspicious. When the number of cases is low, VDRL/TPHA should be selected, and the results should be verified if they are inconsistent. However, the demographic characteristics of patient groups are also important in test selection and work flow. False positive results are troublesome in case of marriage pre-screening and false negative results in sex workers. When all these factors are taken into consideration it may be suggested that either ELISA or VDRL together with TPHA should be performed and the results should be confirmed by a reference test in case of borderline results in ELISA or inconsistency between VDRL and TPHA results. Although screening for syphilis in the setting of blood banking is a matter of debate, if it is to be performed, then ELISA would be better since the work load is high. In case of pregnancy inconsistent VDRL and TPHA results should be verified since no risk could be afforded.
[Show abstract][Hide abstract] ABSTRACT: Aim:Until recently, the tuberculin skin test (TST) has been the only assay used for detecting latent tuberculosis infection (LTBI), but two ex-vivo tests, used as alternative methods to TST, based on enumerating the M. tuberculosis-specific interferon (IFN)-γ response are now commercially licensed. The aim of this study was to compare the sensitivity and specificity of TST, QuantiFERON Gold (QFT-G), and T-SPOT.TB in diagnosing LTBI and active tuberculosis (TB).& Materials and methods: This study was carried out with 95 participants including 3 groups (negative control, close contact, and patient groups) during a 10-month period from March 2007 to January 2008.& Results:When the cut-off value of the TST was regarded as ≥15 mm, 46.4% of the patients and 14.3% of the control group were found to have positive values. The sensitivity (51.4%) and the negative predictive value (NPV) (52.6%) of TST were lower than the specificity (83.3%) and the positive predictive values (PPV) (82.6%). The sensitivity and the PPV of the QFT-G test (78.4% and 76.3%, respectively) were higher than the specificity (62.5%) and NPV (65.2%). The PPV (81.8%) of the T- SPOT.TB test was higher than sensitivity (73.0%), specificity (75.0%), and NPV (64.3%).& Conclusion: IFN-γ tests could be useful in diagnosing LTBI and chemo-prophylaxis, as the false negativity of the TST was higher compared to both QFT-G and T-SPOT.TB. However, additional studies are needed to assess better the utility of these tests with large populations.
Turkish Journal of Medical Sciences 01/2010; 40(4). DOI:10.3906/sag-0907-85 · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this community-based seroepidemiological survey was to assess the immune status against pertussis among the healthy population in three selected provinces with different geographical and socioeconomical status (Antalya, Diyarbakir and Samsun, located at Mediterrenean, Southeast Anatolia and Black Sea regions of Turkey, respectively) in relation with DwPT (whole cell pertussis vaccine combined with diphtheria and tetanus toxoids) vaccination status. A total of randomly selected 2085 subjects ages between 6 months to > 50 years were included to the study. Serum samples have been screened for the presence of pertussis antibodies by an in house ELISA method with the use of pertussis toxin (PT) and filamentous hemagglutinin (FHA) antigens. The levels of > or = 10 EU/mL was accepted as positive for anti-PT and anti-FHA. Vaccination rate with 3-4 doses among children under 15 years old was significantly lower in Diyarbakir compared to the other two provinces (p< 0.05). The antibody positivity was increased with age up to the 10-14 year group and was maintained among older groups. There was no statistically significant relationship between the vaccination rate and antibody prevalence (p> 0.05). Adult females showed a significantly higher antibody-positivity rate for anti-PT than the males (p< 0.05). Our study pointed out a high prevalence of pertussis infection in those selected provinces, suggesting that the adults play a role as potential reservoirs for B. pertussis. It can be concluded that adult immunization, especially of those who are likely to have close contact with infants, should be considered.
[Show abstract][Hide abstract] ABSTRACT: In coproparasitological examination, there is need to perform concentration methods in order to increase the probability of finding helminth eggs and protozoa cysts in addition to the widely used direct examination, especially when they are low in number. In this study, seven concentration methods were investigated on 134 fecal specimens as to their conformity of test results, difficulties in performing the test or interpretation, the time required and the cost. The methods compared were flotation methods using ZnSO4, modified ZnSO4, saturated NaCl and Sheather's sugar flotation and sedimentation methods using Ritchie formalin-ether, modified Telemann and simple sedimentation. Statistical analysis was performed with kappa and McNemar tests. The procedure of the methods were more troublesome when sedimentation techniques were performed, interpretation was easy for helminth eggs but difficult for protozoa cysts with all of the methods, the time required varied between 7-50 minutes, and none of them were expensive. Every laboratory can make their own choices depending upon their conditions, but according to the results of this study, it is apparent that simple sedimentation techniques together with the modified ZnSO4 flotation method would increase the success of the laboratory in diagnosis.
Turkiye parazitolojii dergisi / Turkiye Parazitoloji Dernegi = Acta parasitologica Turcica / Turkish Society for Parasitology 02/2007; 31(2):123-8.
[Show abstract][Hide abstract] ABSTRACT: Seroepidemiological studies need sensitive, practicle and cost-effective methods. For pertussis serosurveillance, an in-house ELISA for antipertussis-toxin (PT) and anti-filamentous-hemagglutinin (FHA) were established in our laboratory and compared by a Ball-ELISA which had been reported to be reliable previously. Sixty sera with various antibody titers were tested by both of the methods. The correlation coefficients between two methods were 0.729 and 0.776 for anti-PT and anti-FHA, respectively, and regression coefficients were 0.623 and 0.693, respectively. The in-house ELISA was applied to a serosurvey including 373 healthy subjects (6 months-91 years old) in Turkey to observe the results. The moving averages of both antibodies were increased until 10 years old, reaching to 31 EU/ml for anti-PT and 65 EU/ml for anti-FHA and kept around this level in the older ages. The in-house ELISA was found to be reliable and the serosurvey results obtained by ELISA showed a characteristic distribution of antibody titers in each age group.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to demonstrate the presence of Q fever infection in three selected provinces, located in South Anatolia, Southeast Anatolia and Black Sea regions of Turkey. Specimens of 339 healthy subjects (114 from Antalya, 116 from Diyarbakir, and 109 from Samsun) were randomly selected from serum samples that are stored in National Serum Bank, Refik Saydam National Hygiene Center, and tested for the presence of IgG antibodies against Coxiella burnetii phase II antigen by using indirect immunofluorescent antibody (IFA) test with a commercial kit (Vircell, SL Granada, Spain). IgG antibodies were accepted positive in case of > or = 1:64 titers, and negative in case of < 1:64 titer, according to the test guidelines. IgG seropositivity rates were found 13.2% (n: 15), 6% (n: 7) and 1.8% (n: 2), in Antalya, Diyarbakir and Samsun provinces, respectively, with an overall rate of 7.1% (n: 24). By logistic regression analysis on the positive IgG antibodies, no significant differences were shown in terms of age, gender and residence in all the three selected provinces, but seropositivity rate was significantly higher in Antalya (OR=8.21, %95 GA=1.82-36.96). The study results showed that Q fever exists in Turkey, and it is necessary to take control measures against this disease.
[Show abstract][Hide abstract] ABSTRACT: Between the dates of May 4th-August 6th 2002, 46 cases were detected with abdominal pain nausea, vomiting, arthralgia/myalgia, headache, fever, diarrhea and rash, in the middle Blacksea and north inner Anatolia regions. Their laboratory findings yielded elevated levels of liver enzymes (AST, ALT, LDH), leucopenia and thrombocytopenia. As the infection was treated easily with tetracyclines, clinical diagnosis was considered to be rickettsiosis or ehrlichiosis. Serum and blood samples obtained from some of the patients were tested against Rickettsia, Ehrlichia, Leptospira and Coxiella, in the national and international laboratories. Samples from 19 patients were sent to National Reference Centre and WHO Collaborating Centre for Rickettsial Reference and Research Laboratory, France, and 7 of them were reported as acute Q fever while 8 of them were reported as passed Q fever (QF) cases. In May 2003, new cases with similar symptoms have been reported from the same regions, with different epidemiologic and serologic findings (tick exposure history was higher, response to tetracycline was lower, C. burnetii antibodies were negative), indicating a viral etiology. The samples of these patients have been sent to National Reference Centre and WHO Collaborating Centre for Arboviruses and Viral Heamorrhagic Fevers, France, and the initial reports were marked as Crimean Congo hemorrhagic fever virus (CCHFV). Then the serum samples of previous 26 patients which were stored in National Serum Bank have been retrospectively investigated for viral aetiology in the same center, and 17 of them have been found positive for CCHFV IgM antibodies. Four of these patients were diagnosed as acute QF in 2002, one was passed QF, 2 were negative for QF and 10 were patients not investigated for QF. As a result, the detection of the both infections together in the same area shows the essential need for further epidemiological investigations.
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was the detection and comparison of measles antibody titers with particle agglutination (PA) and neutralization (Nt) methods, in the sera samples of 364 subjects from different age groups. PA method was performed with a commercial test kit (Serodiameasles, Fujirebio Com. Japan), and Nt test which was standardized in this study, by using COBL (cord blood) cell lines, has been started to use in our laboratory as a reference method. As a result, antibody titers detected by PA were in parallel to the titers which detected by Nt test, and it was concluded that the differences in antibody titers would arise from the differences of test principles and viral antigens.
[Show abstract][Hide abstract] ABSTRACT: Microorganisms such as Pseudomonas aeruginosa, Staphylococcus aureus and Haemophilus influenzae frequently cause colonization and infection in airways of patients with cystic fibrosis. Burkholderia cepacia has also been isolated in patients with cystic fibrosis since 1980. In this study, we aimed to determine the colonization rate of B. cepacia in 286 sputum samples obtained from 129 cystic fibrosis patients. Selective media for B. cepacia were used besides the routine microbiological media in order to increase the isolation rate. The colonies were identified by biochemical tests and the antibiotic susceptibilities of the strains were determined by disc diffusion method. Pathogenic bacteria (S. aureus, P. aeruginosa, Enterobacteriaceae, Streptococcus pneumoniae, H. influenzae) were isolated in 52 of 129 patients (40%) and 66 of 286 sputum samples (23%). In addition 2 B. cepacia strains were isolated from two different patients (1.55%). B. cepacia is now being considered as a pathogen isolated from sputum samples of patients with cystic fibrosis with an increasing frequency and causing severe clinical features. According to these results it can be concluded that, the use of selective media for B. cepacia isolation, should be taken into consideration especially by the clinical microbiology laboratories collaborating with the cystic fibrosis centers.